Intakes of Vitamins and Minerals in Relation to Urinary Incontinence, Voiding, and Storage Symptoms in Women: A Cross-Sectional Analysis from the Boston Area Community Health Survey

doi:10.1016/j.eururo.2011.03.008

European Urology

Volume 59, Issue 6, June 2011, Pages 1039-1047

https://doi.org/10.1016/j.eururo.2011.03.008 Get rights and content

Abstract

Background

Whether lower urinary tract symptoms (LUTS), including voiding, storage, and urinary incontinence, are affected by dietary micronutrients is uncertain.

Objective

To test the hypothesis that carotenoid, vitamin C, zinc, and calcium intakes are associated with LUTS and urinary incontinence in women.

Design, setting, and participants

During an observational, cross-sectional, population-based epidemiologic study of 2060 women (30–79 yr of age) in the Boston Area Community Health (BACH) survey (2002–2005), data were collected by validated food frequency questionnaire and in-person interviews and analyzed using multivariate regression.

Measurements

LUTS, storage, and voiding symptoms were assessed using the American Urological Association Symptom Index (AUASI) and a validated severity index for urinary incontinence.

Results and limitations

Women who consumed high-dose vitamin C from diet and supplements were more likely to report storage symptoms, especially combined frequency and urgency (≥500 vs <50 mg/d; odds ratio [OR]: 3.42; 95% confidence interval [CI], 1.44–8.12). However, greater consumption of dietary vitamin C or β-cryptoxanthin was inversely associated with voiding symptoms (p_trend ≤ 0.01). Both dietary and supplemental calcium were positively associated with storage symptoms (eg, supplement ≥1000 mg/d vs none; OR: 2.04; 95% CI, 1.35–3.09; p_trend = 0.0002). No consistent associations were observed for β-carotene, lycopene, or other carotenoids, although smokers using β-carotene supplements were more likely to report storage problems. Whether the observed associations represent direct causes of diet on LUTS is uncertain.

Conclusions

High-dose intakes of vitamin C and calcium were positively associated with urinary storage or incontinence, whereas vitamin C and β-cryptoxanthin from foods and beverages were inversely associated with voiding symptoms. Results indicate that micronutrient intakes may contribute to LUTS in dose-dependent and symptom-specific ways. Further study is needed to confirm these findings and their relevance to clinical treatment decisions.

Introduction

Approximately one-fifth of the female population suffers from lower urinary tract symptoms (LUTS), such as urination urgency, frequency, voiding, and leakage [1], [2], [3]. Although LUTS in men are often attributable to benign prostatic hyperplasia (BPH), various origins for the pathogenesis of LUTS in women have been suggested, including increased autonomic nervous system activity, detrusor sensitivity, endothelial dysfunction, chronic inflammation, and oxidative damage [4], [5], [6], [7]. Numerous studies have provided evidence that decreased abdominal obesity and increased physical activity may improve LUTS—particularly urinary incontinence—in women [2], [8]. The role of diet, however, has been relatively under-researched, despite plausible mechanisms of action of nutrients via antioxidant pathways or irritable effects on the bladder.

Of the few previous studies examining dietary micronutrients in relation to LUTS, the majority have focused on BPH in men, generally finding inverse associations with vitamin C, carotenoids, and zinc [9], [10], [11], [12]. To date, the only epidemiologic study to have published data on the relationship between dietary micronutrient composition and LUTS in women has been the UK Leicestershire MRC Incontinence Study, which examined 1-yr incidence of overactive bladder (OAB; as defined by urgency symptoms or urge urinary incontinence) or stress-related urinary incontinence [13], [14]. Results showed positive associations between zinc and stress urinary incontinence [13] but not OAB [14]; otherwise, there were few consistent associations with micronutrients. However, the multivariate models did not consider potentially important confounders, such as waist circumference or comorbidities [15]. Furthermore, it remains uncertain whether associations differ for other LUTS subtypes, which may involve unique pathophysiologic mechanisms. To further investigate associations between micronutrients and LUTS in women, we used data from a population-based survey focused on urologic symptoms, with extensive data on lifestyle and medical factors: the Boston Area Community Health (BACH) survey. Previously, we had published findings from BACH showing that greater intakes of total energy and saturated fat versus polyunsaturated fat were positively associated with LUTS and urinary incontinence in women [16], [17]. Given the possibility that oxidative stress may contribute to LUTS, in this analysis, we examined associations between micronutrients with antioxidant capacity—particularly carotenoids, vitamin C, and zinc—and moderate to severe LUTS in women.

Section snippets

Methods

We analyzed cross-sectional, observational, epidemiologic data using case-control methods. Data were from the BACH survey—a population-based, random, stratified sample survey of urologic symptoms and risk factors [18]. From 2002 to 2005, BACH recruited 3202 women 30–79 yr of age from three racial/ethnic groups in Boston, Massachusetts. All participants provided written informed consent. The study was approved by the New England Research Institutes’ institutional review board.

Participants

Results

Of the 2060 women in this analysis, 425 (17.6% weighted) had moderate to severe total LUTS, 8.3% had voiding symptoms, and 35.2% had storage symptoms. Among women with storage symptoms, frequency (66.1%) and nocturia (52.0%) were most prevalent. Urinary incontinence was present in 257 (12.5%) women, most commonly (43.9%) mixed stress and urge types. The voiding symptoms most frequently reported were intermittency (3.5%) and incomplete emptying (4.9%). Overall, women with LUTS were older; less

Discussion

In this population-based, cross-sectional study of women, we observed associations between intakes of certain micronutrients and LUTS that varied by symptom subtype. For example, women consuming high-dose vitamin C from diet and supplements were more likely to report storage symptoms, particularly frequency and urgency. However, dietary vitamin C and β-cryptoxanthin were inversely associated with voiding symptoms. No consistent associations were observed for dietary β-carotene, lycopene, or

Conclusions

Strengths of this analysis are the use of a population-based, racially/ethnically diverse sample of women and validated measures for diet and LUTS. Overall, these findings suggest that for some women, OAB symptoms of frequency and urgency could possibly be ameliorated by modifying high-dose supplements of vitamin C and—among smokers—β-carotene. Above moderate absorbable doses, very high doses of vitamin C may be less likely to offer health benefits while possibly irritating the bladder. If

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Role of dietary food intake patterns, anthropometric measures, and multiple biochemical markers in the development of pregnancy-specific urinary incontinence in gestational diabetes mellitus
2024, Nutrition
The aim of this study was to assess maternal dietary food intake patterns, anthropometric measures, and multiple biochemical markers in women with gestational diabetes mellitus and pregnancy-specific urinary incontinence and to explore whether antedating gestational diabetes mellitus environment affects the pregnancy-specific urinary incontinence development in a cohort of pregnant women with gestational diabetes mellitus and pregnancy-specific urinary incontinence.
Maternal dietary information and anthropometric measurements were collected. At 24 wk of gestation, with a fasting venipuncture sample, current blood samples for biochemical markers of hormones, vitamins, and minerals were analyzed. The groups were compared in terms of numerical variables using analysis of variance for independent samples followed by multiple comparisons.
Of the 900 pregnant women with complete data, pregnant women in the gestational diabetes mellitus pregnancy-specific urinary incontinence group had higher body mass index during pregnancy, arm circumference, and triceps skinfold than the non–gestational diabetes mellitus continent and non–gestational diabetes mellitus pregnancy-specific urinary incontinence groups, characterizing an obesogenic maternal environment. Regarding dietary food intake, significant increases in aromatic amino acids, branched-chain amino acids, dietary fiber, magnesium, zinc, and water were observed in pregnancy-specific urinary incontinence group compared with the non–gestational diabetes mellitus continent group. Serum vitamin C was reduced in the gestational diabetes mellitus pregnancy-specific urinary incontinence group compared with the non–gestational diabetes mellitus pregnancy-specific urinary incontinence group.
This study emphasizes the necessity for a comprehensive strategy for gestational diabetes mellitus women with pregnancy-specific urinary incontinence in terms of deviation in maternal adaptation trending toward obesity and maternal micronutrients deficiencies.
Low-fat dietary pattern reduces urinary incontinence in postmenopausal women: post hoc analysis of the Women's Health Initiative Diet Modification Trial
2022, AJOG Global Reports
Citation Excerpt :
Incident UI was twice as likely to occur among participants with the highest dietary fat intake than those with the lowest dietary fat intake.10 In addition, specific micronutrients have been associated with risk of onset of lower urinary tract symptoms.9,11 Considering these data, we hypothesized that, apart from the association with weight, a low-fat diet reduces UI in postmenopausal women.
Urinary incontinence affects >40% of women in the United States, with an annual societal cost of >$12 billion and demonstrated associations with depressive symptoms, social isolation, and loss of work productivity. Weight has been established as an exposure that increases urinary incontinence risk and certain dietary components have been associated with urinary incontinence symptoms. We hypothesized that diet plays a key role in the association between weight and urinary incontinence in US women.
This study aimed to examine the effect of a low-fat diet on urinary incontinence in postmenopausal women as a post hoc analysis of a randomized controlled trial of diet modification.
This was a post hoc analysis of the Women's Health Initiative Dietary Modification randomized controlled trial of 48,835 postmenopausal women from 40 US centers assigned to a dietary intervention (20% energy from fat, 5 fruits or vegetable servings, and 6 whole grain servings daily and an intensive behavioral modification program) or to the usual diet comparison group. The outcome was urinary incontinence at 1 year.
Of the participants, 60% were randomized to the usual diet comparison group and 40% to the dietary modification intervention. After adjusting for weight change, women assigned to the dietary modification intervention were less likely to report urinary incontinence (odds ratio, 0.94; 95% confidence interval, 0.90–0.98; P=.003), more likely to report urinary incontinence resolution (odds ratio, 1.11; 95% confidence interval, 1.03–1.19; P=.01), and less likely to develop urinary incontinence (odds ratio, 0.92; 95% confidence interval, 0.87–0.98; P=.01) in adjusted models.
Dietary modification may be a reasonable treatment for postmenopausal women with incontinence and also a urinary incontinence prevention strategy for continent women. Our results provide evidence to support a randomized clinical trial to determine whether a reduced fat-intake dietary modification is an effective intervention for the prevention and treatment of urinary incontinence. In addition to providing further insights into mechanisms of lower urinary tract symptoms, these findings may have a substantial impact on public health based on the evidence that diet seems to be a modifiable risk factor for urinary incontinence.
Beneficial relevance of vitamin D concentration and urine flow rate
2021, Clinical Nutrition
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It can only be speculated that vitamin D deficiency will indirectly affect detrusor function in urine storage and voiding, leading to voiding symptoms or underactive bladder. Patients with vitamin D deficiency also show skeletal muscle loss or sarcopenia, and degeneration of the pelvic floor muscles causes patients to experience symptoms of stress urinary incontinence (UI) [4,20–25]. The most common cause of bladder outlet obstruction is benign prostatatic hyperplasia (BPH) in males.
Micturition dysfunction is a problem in the general population that progresses with aging in both males and females. In the past few decades, the relationship between voiding symptoms and body biochemical status has been a subject of research in several disciplines. Micronutrition is considered to affect different aspects of urinary flow, including neuroregulation, detrusor muscle function, and the structures around the bladder outlet such as the pelvic floor and prostate. Therefore, the objective of our study was to determine the correlation between urine flow rate (UFR) and 25-hydroxyvitamin D (25(OH)D) in the general healthy population.
Our study involved 3981 adult participants over age 20 from the U.S. National Health and Nutrition Examination Survey datasets (2011–2012). The associations between UFR and serum 25(OH)D concentration were analyzed through multivariate regression models.
There was a significant positive association of serum 25(OH)D concentration with UFR (25(OH)D₂+25(OH)D₃: β coefficient: 0.003; 95% CI: 0.002, 0.004; p < 0.001, 25(OH)D₃; p = 0.003; epi-25(OH)D₃, p = 0.020) in an unadjusted model. The substantial associations were still observed in the gender and age subgroups. In analysis of age subgroup, the association of serum 25(OH)D concentration with urine flow rate was significant in fully adjusted model (age<60: 25(OH)D₂+25(OH)D₃: β coefficient: 0.004, p < 0.001; 25(OH)D₃: p = <0.001, epi-25(OH)D₃: p = 0.007; Age≥60: 25(OH)D₂+25(OH)D₃: β coefficient: 0.004, p = 0.002; 25(OH)D₃: p = 0.001, epi-25(OH)D₃: p = 0.001). In gender subgroup analysis, the β coefficient of 25(OH)D₂+25(OH)D₃ in male is 0.004 (p < 0.001), and in female is 0.004 (p < 0.001) in fully adjusted model. The higher quartiles of UFR tended to have higher 25(OH)D₃ levels with statistically significant in quartile-based analysis.
UFR was associated with increased level of total vitamin D and bioactive form vitamin D₃. Vitamin D supplements may be a simple and effective way of improving of bladder function.
Future Directions of Research and Care for Urinary Incontinence: Findings from the National Institute of Diabetes and Digestive and Kidney Diseases Summit on Urinary Incontinence Clinical Research in Women
2017, Journal of Urology
Citation Excerpt :
Physical activity may decrease UI risk through weight loss or UI may inhibit physical activity, or both factors may apply. Increased intake of dietary and supplemental calcium is associated with greater risk of UI.24 UI persistence may also be associated with alcohol consumption.17
Female urinary incontinence is prevalent, costly and morbid. Participants in a NIDDK (National Institute of Diabetes and Digestive and Kidney Diseases) sponsored summit reviewed findings from NIH (National Institutes of Health) funded clinical research on urinary incontinence in women and discussed the future of urinary incontinence research.
The NIDDK convened the Summit on Urinary Incontinence Clinical Research in Women on March 14, 2014. Participants representing a broad range of clinical expertise reviewed completed NIH sponsored urinary incontinence related studies, including results from community based epidemiological studies such as the BACH (Boston Area Community Health) Survey and from randomized clinical trials such as PRIDE (Program to Reduce Incontinence by Diet and Exercise), and studies conducted by the Pelvic Floor Disorders Network and the Urinary Incontinence Treatment Network.
BACH Survey results improved our understanding of precursors, incidence, prevalence and natural history of urinary incontinence in a diverse group of women. The Pelvic Floor Disorders Network study found that anticholinergic medications and onabotulinumtoxinA are efficacious for treating urge urinary incontinence, and Burch colposuspension and retropubic mid urethral polypropylene slings are efficacious for decreasing stress urinary incontinence following pelvic organ prolapse surgery in women with potential stress urinary incontinence. The Urinary Incontinence Treatment Network study found that fascial slings were better than colposuspension, and that retropubic and transobturator mid urethral polypropylene slings were equivalent for stress urinary incontinence. In patients with stress urinary incontinence a preoperative urodynamic study was noninferior to basic office examinations for surgical outcome. The addition of behavioral intervention did not allow female patients to discontinue antimuscarinics for urge urinary incontinence. PRIDE showed that modest weight reductions significantly decreased urinary incontinence.
Strategies for future research on urinary incontinence should include a focus on early disease, risk factor identification, better phenotyping, incorporation of new technologies, patient centered research and prevention.
Advancing a Comprehensive Approach to the Study of Lower Urinary Tract Symptoms
2016, Journal of Urology
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This investigation was unique in that it was population based and assessed a broad range of factors, including sociodemographic characteristics, health care access/utilization, lifestyle/behavioral factors, psychosocial factors, health status, physical measures and biochemical parameters. Subsequently BACH investigators have reported a broad array of dietary and lifestyle factors associated with LUTS, including beverage consumption, vitamin and mineral consumption, use of psychoactive medications, dietary macronutrient consumption, cholesterol and sodium levels, physical activity, smoking, alcohol consumption and vitamin C intake.28–33 There is worldwide interest in lifestyle factors, with individual studies conducted in England,34,35 Japan,36 Taiwan,37 Australia,38,39 Norway,40 China41,42 and Korea,43 as well as multinational studies.44
Lower urinary tract symptoms are common in the United States population, leading to significant economic, quality of life and public health issues. The burden will increase as the population ages, and risk factors for lower urinary tract symptoms, including diabetes and obesity, remain highly prevalent. Improving clinical management and establishing the knowledge base to prevent lower urinary tract symptoms will require a comprehensive research approach that examines factors beyond the lower urinary tract. While the study of extra-lower urinary tract factors has increased recently, current urological research does not systematically account for the broad set of potential contributing factors spanning biological, behavioral, psychological/executive function and sociocultural factors. A comprehensive assessment of potential contributors to risk, treatment response and progression is necessary to reduce the burden of this condition in the United States.
We considered challenges to continuing the predominantly lower urinary tract dysfunction centric approach that has dominated previous research of lower urinary tract symptoms.
We developed a new, comprehensive framework for urology research that includes a broader set of potential factors contributing to lower urinary tract symptoms. This framework aims to broaden research to consider a comprehensive set of potential contributing factors and to engage a broad range of researchers in the investigation of as many extra-lower urinary tract factors as possible, with the goal of improving clinical care and prevention.
We propose a new framework for future urology research, which should help to reduce the medical and economic burden of lower urinary tract symptoms in the United States population.
You are what you eat: The impact of diet on overactive bladder and lower urinary tract symptoms
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Overall there was no association between the development of stress or urgency incontinence with the reported dietary intake of isoflavones, coumestrol and ligans suggesting that dietary intake of phytoestrogens has little impact on urinary symptoms. The effects of vitamin intake on lower urinary tract dysfunction have now been assessed in a number of different studies including a sub group analysis of the Boston Area Community Heath survey [23]. This large observational, cross sectional, population based study of 2060 women has demonstrated that women who consumed high dose vitamin C were more likely to report the storage symptoms of frequency and urgency although consumption was inversely associated with voiding symptoms.
Overactive bladder (OAB) is a clinical syndrome describing the symptom complex of urgency, with or without urgency incontinence and is usually associated with frequency and nocturia. The symptoms associated with OAB are common and whilst not life threatening are known to have a significant impact on the quality of life (QoL).
There is increasing evidence that diet may have a significant role in the development of OAB symptoms. Whilst fluid in-take is known to affect lower urinary tract function the effects of caffeine, carbonated drinks and artificial sweeteners are less well understood.
Consequently the aim of this paper is to review the evidence and investigate the effect of diet on lower urinary tract function and dysfunction.

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Female Urology – IncontinenceIntakes of Vitamins and Minerals in Relation to Urinary Incontinence, Voiding, and Storage Symptoms in Women: A Cross-Sectional Analysis from the Boston Area Community Health Survey

Abstract

Background

Objective

Design, setting, and participants

Measurements

Results and limitations

Conclusions

Introduction

Section snippets

Methods

Results

Discussion

Conclusions

J Urol

Eur Urol

Urology

Am J Clin Nutr

Eur Urol

J Nutr

Eur Urol

Eur Urol

Mutat Res

J Urol

Eur Urol

Eur Urol

Eur Urol

J Urol

Urology

J Clin Epidemiol

Prevalence of lower urinary tract symptoms and effect on quality of life in a racially and ethnically diverse random sample: the Boston Area Community Health (BACH) survey

Arch Intern Med

Prevalence of and risk factors for urine leakage in a racially and ethnically diverse population of adults: the Boston Area Community Health (BACH) survey

Am J Epidemiol

Lower urinary tract symptoms: lack of change in prevalence and help-seeking behaviour in two population-based surveys of women in 1991 and 2007

BJU Int

Female Urology – Incontinence
Intakes of Vitamins and Minerals in Relation to Urinary Incontinence, Voiding, and Storage Symptoms in Women: A Cross-Sectional Analysis from the Boston Area Community Health Survey